Chiropractic Case Study

Barbara Bellione

In this case, failure to obtain informed consent for chiropractic treatment proved problematic for the chiropractor.

Claimant and Condition:

Louise Norman wasa 49-year-old married hair stylist at the time of her initial visit with Kevin Farrow, DC. She had traveled out of state to visit her daughter and new grandchild for a few weeks. Norman had been receiving periodic chiropractic treatment since a motor vehicle accident 15 months earlier and wanted to continue chiropractic treatment while she was away from home. A family member referred her to Dr. Farrow.

Dr. Farrow’s initial evaluation of Ms. Norman occurred on March 26, 2004. She had complaints of neck, mid back, low back, hip and left ankle pain which she said resulted from the motor vehicle accident. She reported that her last chiropractic treatment had been two weeks prior to her appointment with Dr. Farrow.

Treatment:

Dr. Farrow performed an evaluation and found Ms. Norman to have limited range of motion in her cervical spine. She had palpatory tenderness in C1-C3, T5-T7, and L5-S1. Dr. Farrow also noted structural distortion with bilateral ankle pronation. Following the initial examination, Dr. Farrow adjusted Ms. Norman’s neck, mid back, low back and bilateral ankles.Dr. Farrow adjusted the right ankle, even though Ms. Norman had no complaints of right ankle pain, because he felt Ms. Norman was compensating for her left ankle pain with her right ankle.

Ms. Norman called Dr. Farrow three days later complaining of right ankle pain. Dr. Farrow instructed her to elevate the ankle, apply ice, and rest the ankle. Dr. Farrow called her back the next day to check on her condition. Ms. Norman again reported right ankle pain.

Ms. Norman came into the office on March 29, 2004. She continued to complain of right ankle pain so Dr. Farrow took x-rays of the right ankle. The x-rays were negative for fracture and dislocation. However, the x-rays were positive for a large spur on the right talus. Dr. Farrow instructed Ms. Norman to continue elevating and icing her ankle.

She returned on March 31, 2004, still complaining of right ankle pain. At this visit, she was noted to have swelling and pain at the lateral malleolus region upon palpation.

At the last appointment on April 2, 2004, Ms. Norman complained of persistent right ankle pain and Dr. Farrow referred her to a podiatrist. The podiatrist found Ms. Norman to have decreased reflexes in the right ankle. He referred her to a neurologist who performed EMG and nerve conduction study examinations. The studies were essentially normal.The podiatrist eventually diagnosed Complex Regional Pain Syndrome within a few weeks of Dr. Farrow’s treatment of Ms. Norman and referred her to a pain management center for treatment.

Misadventure and Injury:

The diagnosis of CRPS was subsequently confirmed by a number of medical practitioners, all of whom indicated that Ms. Norman’s symptoms began after Dr. Farrow’s manipulation of her ankles.As a result of her symptoms, she underwent multiple epidural injections and physical therapy. She wears a support on her right ankle and has been prescribed multiple pain medications.

Ms. Norman hired an attorney and filed a lawsuit against Dr. Farrow.

Allegations against the insured chiropractor included:

  • Negligent adjustment of both ankles without consent;
  • Unnecessary adjustments were performed in a negligent/aggressive manner;
  • Performance of unnecessary adjustments resulted in Complex Regional Pain Syndrome and significant disability, extensive medical/therapeutic treatment, and loss of earnings and earning capacity.

Defending the Claim:

The discovery process yielded the following:

  • Dr. Farrow admitted he did not advise Ms. Norman of any potential risks and complications of chiropractic treatment. He also indicated that he was unaware of any risks.
  • X-rays of the ankles were performed only after an adjustment of the ankles was performed.
  • Ms. Norman had initial complaints of CRPS immediately following Dr. Farrow’s care.
  • An expert chiropractic reviewer provided a favorable standard of care review. However, in the jurisdiction where the claim arose, Dr. Farrow could be held liable for any harm a jury believed arose from his treatment since there was no consent discussion or any documentation regarding consent for chiropractic care.

Outcome:

Ms. Norman demanded $100,000 to settle the claim. Due to possible liability exposure for lack of informed consent, the defense team and Dr. Farrow agreed that attempts should be made to settle the claim prior to trial. Settlement negotiations ensued and the claim was settled for $49,890.

Risk Management Pointers

  • Obtain informed consent for chiropractic treatment prior to performing treatment.
  • The following information should be discussed with the patient and documented in the patient’s record:
  1. The nature of the patient’s condition, the diagnosis, the proposed treatment plan and the prognosis.
  2. A description of the recommended procedure or treatment and its purpose.
  3. The probable outcome, particularly if it is difficult to predict, and the patient’s expected post-procedure/treatment course.
  4. The most likely risks and side effects, the potential benefits, as well as the potential complications of the procedure or treatment.
  5. Reasonable alternative methods of treatment or non-treatment including the risks, benefits, complications, and the prognosis associated with each alternative or with non-treatment.

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Barbara Bellione is the director of Risk Management for the OUM Chiropractor Program. OUM provides professional liability insurance to chiropractors nationwide and is underwritten by either PACO Assurance or PICA, both A- rated by industry analyst, AM Best. Barbara resides in Franklin, TN, with her husband and furry children.

Sample Consent for Chiropractic Treatment

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